title: Outcomes of metallic biliary stent insertion in patients with malignant bilobar obstruction.
abstract: OBJECTIVE
  To assess clinical outcomes of metal stent insertion in patients with bilobar bile duct obstruction by malignant tumors.
  
  
  METHODS
  Records of 120 consecutive patients who underwent placement of metallic stents for palliation of malignant bilobar biliary obstruction between 1995 and 2010 were retrospectively reviewed. Single-duct stent insertion was performed in 44 patients with one liver lobe that accounted for more than 70% of total liver volume or only one patent lobar portal vein (group 1). Bilobar stent insertion was performed in 60 patients with approximately equal lobe sizes, patent lobar portal veins, or cholangitis at presentation (group 2). In 16 patients with discontiguous right anterior and posterior segmental ducts (group 3), three stents were deployed in the left lobar and right anterior and posterior segmental ducts. Overall survival, primary patency, and patient morbidity rates following stent insertion were assessed.
  
  
  RESULTS
  No significant differences in mean overall survival (group 1, 7.3 mo; group 2, 10.3 mo; group 3, 6.5 mo; P = .21) or mean primary stent patency (group 1, 4.2 mo; group 2, 5.9 mo; group 3, 3.5 mo; P = .17) were demonstrated. However, patients in group 3 were significantly more likely to require hospitalizations for cholangitis and additional invasive procedures for recurrent biliary obstruction than patients in groups 1 and 2.
  
  
  CONCLUSIONS
  Unilobar and bilobar metal stent insertion led to similar outcomes when treatment decision was based on relative liver lobe volumes, lobar portal vein patency, and presence of cholangitis on presentation.
authors.affiliation: Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Veal
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Lee
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000209:etiology / Q000628:therapy; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D010166:Palliative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals